In honor of the Affordable Care Act

In honor of the Affordable Care Act

Many of us held our collective breaths in anticipation of the Supreme Court decision and relaxed as we read the ruling. Although the ruling will not improve coverage for abortion services, the ACA will promote affordable contraception for women. As of August 1, 2012 specifically designated women’s health preventive care services will be covered by all insurance plans without cost sharing, meaning that insurances cannot charge a co-payment, co-insurance or a deductible. These services include well-woman visits, breastfeeding support, domestic violence screening, and contraception. The details are still unfolding and we do not yet know if this means plans will cover all brands of contraceptives (unlikely). However, plans must cover all types of methods. Some plans won’t begin to provide the new contraception coverage until the beginning of their new plan year which could be later than August 1. After the uproar from Catholic hospitals and insurance plans, faith-based insurance providers have been given a one year extension of the deadline.

Removing the financial aspect as a barrier to service is an important step forward and has the potential to lower the high unintended pregnancy rate in our country. However, we know from policies in countries with single payer systems that unintended pregnancies still occur although at a lower rate than in the U.S. The Guttmacher Institute studied sexual and reproductive patterns specifically in the teenager population in Great Britain, Canada, France, Sweden and the United States. They found that although the rate of sexual activity among U.S. teens is similar to other developed countries, U.S. teens do not use contraceptives as often as teens in other Western countries. Compared to the other four countries, access to health care services and contraception was limited in the United States, where 20 percent of teenagers don’t have health insurance. The Guttmacher researchers suggested that limited access to health care and contraceptives is a major contributing factor to our high unintended pregnancy rate, along with less social acceptance of teenage sexuality.

And as we know from the experience of countries with even the lowest unintended pregnancy rates, abortion will always be a necessary component of comprehensive unintended pregnancy prevention and care. Although difficult to imagine in the current political environment, we can envision, and with commitment and persistent reach, the day in which abortion care is reintegrated into health care reform. Until that day, women will rely on a combination of more accessible contraception and a patchwork system of abortion care providers.

If and to what degree the unintended pregnancy rate declines in the U.S. with the removal of the cost barriers remains to be seen. We can hope, though, can’t we?